Items on the 12-item Multiple Sclerosis Walking Scale (MSWS-12) that assess an individual’s need for support when walking indoors and outdoors can offer significant insight into mobility capabilities of mildly and moderately-severely disabled patients with multiple sclerosis (MS), according to study results published in Multiple Sclerosis and Related Disorders.

Study researchers sought to evaluate the associations between MSWS-12 items and mobility, and the relationship of disability in MS to these. The study was a secondary analysis of a previously published study which included patients with MS from 17 MS centers in Europe and the United States. Patients included in this analysis had a definite MS diagnosis and an Expanded Disability Status Scale (EDSS) score of at least 2 and no more than 6.5. A total of 242 patients with MS completed the Symbol Digit Modalities Test for cognitive status, and the MSWS-12, 2-Minute Walk Test (2MWT), Timed 25-Foot Walk (T25FW), Timed Up and Go Test (TUG), and 4 Square Step Test (FSST) for mobility.

After the completion of these tests, patients were classified into 2 groups based on their level of disability, either mildly disabled (n=108; EDSS≤4) or moderately-severely disabled (n=134; EDSS>4). Spearman’s coefficient correlations were used to examine the association between individual items on the MSWS-12 with clinical mobility measures.

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The overall MSWS-12 score was 37.8. Mildly disabled patients with MS had a lower MSWS-12 score compared with moderately-severely disabled patients (31.9 vs 42.5, respectively). The investigators observed stronger correlations between mobility tests and items on the MSWS-12 in patients who were mildly disabled compared with those who were moderately-severely disabled. 

According to the linear regression analysis of patients in the mildly disabled group, item 9 on the MSWS-12 (necessary use of walking support outdoors) explained 35.4%, 30.8%, and 23.7%, respectively, of the variance associated with 2MWT, T25FW, and TUG. In the patients who were moderately-severely disabled, item 8 on the MSWS-12 (necessary use of walking support indoors) explained 31.6%, 18.0%, 20.2%, and 9.5%, respectively, of the variance associated with the 2MWT, T25FWT, TUG, and FSST.

Limitations of this study were the reliance on clinical walking tests to determine mobility and the lack of instrumented gait devices. Additional limitations included the lack of assessment of other factors associated with mobility, such as muscle strength, lower limb endurance, postural stability, and spasticity.

Based on their findings, the study researchers concluded that items 8 and 9 of the MSWS-12 provide “a robust indicator of the MS individual’s objective mobility capabilities” and that clinicians should “focus on questions relating to the patient’s use of walking support devices” during routine assessment of this population.

Disclosure: This clinical trial was supported by Novartis. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Kalron A, Ehling R, Baert I, et al. Improving our understanding of the most important items of the Multiple Sclerosis Walking Scale-12 indicating mobility dysfunction: Secondary results from a RIMS multicenter study. Mult Scler Relat Disord. Published online September 14, 2020. doi:10.1016/j.msard.2020.102511